Q: Larry, does the President have any reaction to the announcementthe
Centers for Disease Control in Atlanta, that AIDS is now an epidemic
and have over 600 cases?
MR. SPEAKES: What's AIDS?
Q: Over a third of them have died. It's known as "gay plague." (Laughter.)
No, it is. I mean it's a pretty serious thing that one in every three people
that get this have died. And I wondered if the President is aware of it?
MR. SPEAKES: I don't have it. Do you? (Laughter.)
Q: No, I don't.
MR. SPEAKES: You didn't answer my question.
Q: Well, I just wondered, does the President
MR. SPEAKES: How do you know? (Laughter.)
Q: In other words, the White House looks on this as a great joke?
MR. SPEAKES: No, I don't know anything about it, Lester.
Q: Does the President, does anybody in the White House know about this
epidemic, Larry?
MR. SPEAKES: I don't think so. I don't think there's been any
Q: Nobody knows?
MR. SPEAKES: There has been no personal experience here, Lester.
Q: No, I mean, I thought you were keeping
MR. SPEAKES: I checked thoroughly with Dr. Ruge this morning and he's had
no(laughter)no patients suffering from AIDS or whatever it is.
Q: The President doesn't have gay plague, is that what you're saying or
what?
MR. SPEAKES: No, I didn't say that.
Q: Didn't say that?
MR. SPEAKES: I thought I heard you on the State Department over there.
Why didn't you stay there? (Laughter.)
Q: Because I love you, Larry, that's why. (Laughter.)
MR. SPEAKES: Oh, I see. Just don't put it in those terms, Lester. (Laughter.)
Q: Oh, I retract that.
MR. SPEAKES: I hope so.
Q: It's too late.

On October 15, 1982, Larry Speakes, then the spokesperson for President
Ronald Reagan, like most people in the world, had no idea that a new epidemic
disease, acquired immunodeficiency syndrome, was racing around the
United States, Europe, and Africa.

The disease that eventually became known as AIDS likely has existed in
Africa for many decades, if not many centuries. The most probable scenario
is that humans caught it from chimpanzees when trapping or butchering the
animals. Because people with AIDS die from complications like unchecked
tuberculosis, wasting, or pneumonia, no alarm bells would have sounded, as
nothing would have looked unusual. This is especially true given the sorry
state of health care for most Africans, where many children die young and, in
some countries, the majority of adults never reach their 50th birthday.

It is easy to see how, as Africans began migrating to burgeoning cities
and syringes became more common in public health campaigns, AIDS could
have flourished but still remain undetected. Air travel then brought the disease
to Europe, Haiti, and the United States in the late 1960s and early 1970s.
The sexual promiscuity of gay men in these liberated years, where it was not
uncommon for people to have 50 partners in a year, offered the disease a
chance to firmly establish itself on these more developed continents. And
these were places where doctors had been trained to take note of odd cases,
such as young men dying from pneumocystis carinii pneumonia, a normally
wimpy disease.

Five cases of this rarely fatal disease in gay men indeed caught the attention
of a Los Angeles physician in 1981, and he reported his findings on June
5, 1981, in the Morbidity and Mortality Weekly Report, a no-frills, but widely
read publication issued by the U.S. Centers for Disease Control (CDC) to
alert the medical community to public health issues. By October 1982, when
Speakes joked about the emerging epidemic, MMWR had published 11 reports
on AIDS. Articles had appeared in the major medical journals. True, the popular
media had been shy about covering the story, but even by that point it had
appeared on the network news and on front pages of major daily newspapers.
Larry Speakes, in short, should at least have known that AIDS existed.
And his ignorance highlighted the Reagan Administration's indifferenceand
even outright hostilitytoward homosexuals. It also foreshadowed how
unprepared the people at the top were to lead the battle against this burgeoning
epidemic, especially when it came to organizing the search for a vaccine.

Presidents can make enormous differences when it comes to conquering
disease. Fifty years earlier, when thousands of children in the United States
were being crippled each year by polio, President Franklin Delano Roosevelt
organized charity balls on his birthday "to dance so others may walk." These
balls evolved into the National Foundation for Infantile Paralysis, colloquially
known as the March of Dimes, which would successfully lead the campaign
to research and develop the first polio vaccines. But then, FDR had polio himself.
He also appointed his former law partner, Basil O'Connor, to run the
March of Dimes. Ronald Reagan for many years refused even to say the word
"AIDS" in public. And Reagan's top aides had as difficult a time with AIDS
as he did. Consider this exchange between Speakes and journalists at a White
House Press briefing on June 13, 1983:

Q: Larry, does the President think that it might help if he suggested that the
gays cut down on their "cruising"? (Laughter.) What? I didn't hear your
answer, Larry.
MR. SPEAKES: I just was acknowledging your interest
Q: You were acknowledging but
MR. SPEAKES: interest in this subject.
Q: you don't think that it would help if the gays cut down on their cruisingit
would help AIDS?
MR. SPEAKES: We are researching it. If we come up with any research that
sheds some light on whether gays should cruise or not cruise, we'll
make it available to you. (Laughter.)
Q: Back to fairy tales.

Could the person who handled the press for FDR publicly have made
jokes about polio and lived to see the inside of the White House again?

* * *

AT THE TIME Larry Speakes was making fun of gay cruising, Margaret
Heckler had been the Administration's top health official for three months
and was preparing for a speech the next day to the U.S. Conference of
Mayors, at which she would declare that AIDS was the "number one health
priority."

A lawyer by training, Heckler had represented Massachusetts in the
Congress for 16 years before Reagan appointed her to head the Department of
Health and Human Services (HHS), a mammoth agency tasked with overseeing
both the National Institutes of Health (NIH) and the CDC. Heckler's chief of
staff, C. McClain "Mac" Haddow, recalled that his boss knew little about AIDS
when she took the HHS post. So Haddow, a former Utah state representative,
and other staffers scheduled a briefing for her.

To educate Heckler about the disease, they brought in James Mason,
head of the CDC in Atlanta, Georgia. Edward Brandt Jr., the assistant secretary
for Health, also came to the gathering in her office, as did a gay man who
had been a close aide to Heckler since her time on Capitol Hill. Mason
walked Heckler through the basics of how AIDS appeared to be transmitted,
explaining that it focused on homosexuals and why that might be. "He was
talking about anal intercourse and Heckler got this shocked look on her face
and said, `What?'" recalled Haddow. "Jim Mason, who's a very straight-laced
Mormon and was having a little difficulty with this, said the rectal wall
was more fragile than the vaginal wall."

"Anal intercourse?" said Heckler, looking at her trusted, gay staffer.
"You do that?"

Ed Brandt looked at Haddow. "I think we better come back and discuss
this a little later," said Brandt.

Haddow said that everybody in the room was stunned. "Mrs. Heckler
didn't understand that homosexuals engaged in anal intercourse."

* * *

ON APRIL 23, 1984, MARGARET HECKLER summoned Robert Gallo into her
office at the Hubert H. Humphrey Building in Washington, D.C. A prominent
and controversial researcher at the National Cancer Institute (NCI), Gallo
had just raced home from a scientific conference in Italy to attend what would
turn out to be one of the most awkward, confusedand talked aboutscientific
press conferences in history: in a few hours' time, Heckler would
announce that Gallo's lab had found the cause of AIDS, firing the starting gun
for the vaccine search. But before she made this grand declaration, she wanted
Gallo's input about the amount of time it would take to translate his laboratory's
discovery into an AIDS vaccine.

Scientists who make discoveries in basic research long have shied away
from offering predictions about practical outcomes, and reporters long have
hounded scientists to offer just such predictions. Mac Haddow wanted
Heckler to be able to address this question head on, and for days he had been
pressuring the NIH to give him a time line. "The NIH public affairs office
was asked, and they came up with a whole list of possible answers," said
Haddow. "The bottom line was it was going to have to be Gallo's call. And
he would have to be comfortable with it."

When Haddow first began seeking an answer to this question, he thought
he would have several weeks to find an answer. Plans called for announcing
the explosive news of the Gallo lab's discovery in concert with the May 4 issue
of Science, which would contain four back-to-back papers describing how the
lab had fingered a new virus as the culprit and grown large quantities of it. But
Haddow's PR plans became fouled up when news stories hinting at the discovery
began to dribble out during the second week of April. Creating further
grief for HHS, the White House had high hopes of using the news during this
election year to confront criticisms about the Reagan Administration's AIDS
record. At Ed Brandt's urging, Gallo and NIH director James Wyngaarden,
who had traveled together to the conference in Italy, both hastily returned
home to attend this Monday afternoon press conference.

When Gallo, Wyngaarden, and NCI director Vincent DeVita Jr. arrived
at Heckler's office that morning, Haddow quickly dressed them down for a
story that had appeared the day before on page 1 of the New York Times.
Headlined "Federal Official Says He Believes Cause of AIDS Has Been
Found," the article was not about the findings in Gallo's lab. Rather, it quoted
James Mason, head of the CDC, describing the work of researchers at the
Pasteur Institute in France, and Mason said he had not yet seen the papers
from Gallo's lab. Haddow was livid about the perception that the CDC and
the NIHboth of which are part of HHSwere at odds with each other, and
contended that the NIH was to blame for some of the tension between the
institutes. After the bickering about who was at fault died down, Haddow
asked how long it would take to develop a vaccine. The question caught
Gallo unawares. "I hadn't thought about it before we went in there," said
Gallo. "I didn't even anticipate the question."

DeVita and Wyngaarden attempted to convince Haddow that the idea of
offering a time line was a mistake. "People have tried to make vaccines
against all sorts of things, and the record is generally one of failure,"
Wyngaarden said. Wyngaarden had little respect for Haddow, who he
thought was "authoritarian" and "gave the scientific point of view no shrift."
The NIH director, who personally oversaw a $4.5 billion budget (1% of
which went to AIDS) and had extensive clout on Capitol Hill, also had little
respect for Heckler. "The woman was one of the worst listeners I've ever
encountered in any capacity," he said. "She'd listen to one sentence or two,
and then her mouth wouldn't close again."

By all accounts, Gallo came up with the official line: within two years,
an AIDS vaccine would be ready for human testing. "I assume as much credit
or blame for that as anyone," Gallo later acknowledged. Haddow recalled
having "a lengthy discussion about why it was defensible." Said Haddow: "I
wanted to be sure before Heckler said it and was brought into it that there
was a reasonable expectation that we could accomplish that goal."

Brandt, who was also part of these discussions, put great faith in Gallo's
enthusiasm. "He was convinced that he had all the makings of a vaccine, that
he was fully prepared to move on that very quickly, as a matter of fact," said
Brandt. "I really had great confidence in Gallo's ability to pull that off."

Heckler, who had a severe case of laryngitis that day, invited Gallo into
her office for a one-on-one chat.

"Will we be able to get a vaccine?" she asked in her scratchy voice.

Gallo said he believed so. "I just said, `I think, you know, due to the fact
we have an unlimited amount of virus now and we're sure it causes the disease,
I can't think that this should take that long.' I didn't perceive the difficulties."

* * *

HUNDREDS OF JOURNALISTS jammed into the first-floor auditorium of the
Hubert H. Humphrey Building for the 1:15 P.M. press conference. Heckler
stepped up to the lectern first. She had a dyed blonde head of helmet hair, and
its cartoonish effect was exaggerated by her bright red dress, which sported a
high white collar. Behind her, a dramatic, 20-foot-high blue curtain served as
a backdrop. Flanking Heckler were Gallo and the agency's top brass: HHS
assistant secretary Brandt, NIH director Wyngaarden, CDC director Mason,
and NCI director DeVita.

Heckler opened the proceedings with a joke. "As I believe you anticipate,
this press conference will be devoted to the subject of AIDS, in which area
there is, of course, important news," she said from behind the thicket of
microphones sprouting from the lectern. "But, unfortunately, we have not
made similar breakthroughs in the field of laryngitis. So I apologize for the
state of my voice today."

Heckler continued in an increasingly faltering voice. "Today, I am
pleased to whisper"the reporters laughed"that the arrow of funds, medical
expertise, research, and experimentation with the Department of Health
and Human Services, and its allies around the world, have [sic] aimed and
fired at the disease AIDS, and has hit the target only two or three rings from
the bullseye itself."

It would be quickly forgotten, but at the time of this announcement, several
far-flung theories about the cause of AIDS still competed with each other.
Some researchers recently had argued that a fungus caused AIDS. Others
maintained that AIDS was the result of using amyl nitrate inhalants, called
poppers, that many gay men snorted to strengthen the power of orgasm. The
list of suspected causes also included cytomegalovirus, Epstein-Barr virus,
swine flu virus, herpesvirus, and the fanciful idea that several of these possible
causes were assaulting the immune system in concert. Gallo himself for a
time tried to pin the disease on one of the two known human T-cell leukemia
viruses, HTLVs, obscure pathogens recently discovered by his lab.

Only a year before, Gallo and his coworkers had thrust HTLV-I and
HTLV-II into the spotlight when they published, again in Science, two papers
arguing that these viruses were the possible cause of the then two-year-old
AIDS epidemic. Another paper in that 1983 issue from a group headed by Luc
Montagniera researcher at the Pasteur Institute in Paris, France, who
would later enter a protracted battle with Gallo about who deserved credit
for discovering the cause of AIDSbolstered the case. In the subsequent year,
Gallo and his colleagues refined their argument, and now they were contending
that the cause was a new member of this viral family, HTLV-III.

The Gallo lab's four 1984 Science papers showed that they had isolated
HTLV-III from 48 patients with the disease and spelled out how to grow the
virus continually in laboratory cultures, a critical feat because it routinely
killed the cells it infected. Heckler emphasized to the journalists that the ability
to grow the virus in mass quantities would allow scientists to characterize
the agent in detail, understand its behavior, and develop a blood test in as little
as six months. "Finally, we also believe that the new process will enable us
to develop a vaccine to prevent AIDS in the future," she said. "We hope to
have such a vaccine ready for testing in approximately two years."

Heckler proceeded to apportion credit for this discovery to the people
sitting behind her. The next paragraph in her prepared statement, which had
been distributed to the press, praised the work of researchers at the Pasteur
Institute. But Heckler, her voice jumping into what sounded like a helium-induced
register, abruptly abandoned the prepared statement, asking Gallo
and Brandt to come forward.

A hunch-shouldered Gallo moved into the spotlight. With his perpetually
unkempt steel-wool hair, a too-casual camel-colored sport coat, and a
slightly crooked tie, Gallo looked every bit the academic, which was in keeping
with the NIH style. He proceeded to explain himself in a tortured English.
"Many of you, or all of you, have seen discussions about work in Paris," he
said. "There was. There is not. There has never been any fights or controversies
between us and a group in France.... We have active collaboration in
the coming month. If what they identified in Science a year ago is the same as
what we now have produced more than 50 isolates of and in mass production,
and in detailed characterization, if it turns out to be the same, I certainly
will say so, and I will say so with them in collaboration."

Gallo fielded several questions, finally passing on this one: "How many
years will it be before there is a marketable vaccine, based on previous experience?"
Brandt, at Gallo's urging, came forward. "We're estimating a minimum
of two years, probably more like three years," Brandt said. "In two
years, we think it's possible to begin to start human trials. But I think we have
aone of the first steps that has to he accomplished is to mass-produce this
virus in sufficient quantity to accomplish that. So I think we're talking about
probably three years. We're going to hustle." There. Brandt had said it. Three
years until a vaccine was on the market.

"Excuse me," the reporter said. "The French told me this morning that
they would predict at least five years. And Luc Montagnier"this was the
first mention of Montagnier's name at the press conference by anyone"said
he thought it might be five to 10 years. Why are you more optimistic than the
French are?"

"I'm more optimistic, I guess," said Brandt. "I don't know. I'm more
optimistic. Except that I believe it can be done, that's all."

An astute reporter pointed out that there were a number of viruses,
"known for as long as two decades," that scientists had yet to defeat with vaccines.
"Why are you confident that you can get one for AIDS in two years?"

Gallo finally spoke his mind on the question, backpedaling mightily and,
in effect, undermining what he had told Heckler and Haddow earlier. "I believe
that the reason that there's a wide difference in what time it takes, you know, it
obviously is not in the interest of the scientist to give a fast prediction," he said.
"You'll only press us all, say, `Remember what you said eight months ago, four
months ago?' You'll be giving us a clockwatch.... Now your question gets
tricky. How do you know you'll have one that really works in AIDS patients?
Of course, the prediction for that is impossible. You have no hundred percent
proof that it will be two years, a hundred years, or it may never come from vaccination.
It depends on the subtleties of biology. But the principles are there.
The likelihood, the best we can say in science, with the technology available, we
should have things ready to be able to be tried by then."

Brandt and Gallo traded off answering questions, which ranged from
uninformed to insightful, a reflection that the conference had attracted both
general assignment reporters and those who regularly covered the science
beat. The smartest questioners kept returning to the subject of vaccines. "Dr.
Brandt," asked one, "in talking about approval of a vaccine, aren't you sort
of blithely leaping over what could be a very difficult ethical problem, namely,
the testing of this for safety and efficacy on healthy individuals?"

Brandt misunderstood the clairvoyant question. "Absolutely not. I mean,
we would certainly test any vaccine," he said.

Another sharp reporter asked whether they intended to test a live- or a
killed-virus vaccine. These are the traditional methods of making a viral vaccine:
either killing the virus or weakening a live version of it. These modified
versions of the virus then safely can teach the immune system how to defend
itself should the real thing ever invade. "Can you comment on the difficulty
of human clinical trials of such a vaccine?"

Brandt, an earnest and well-meaning man, did not seem to understand
this question either. "Well, we're going to develop the vaccine first," he said.
"Then we'll be ableit depends entirely on what kind of vaccine comes out
of it. So we certainly are not going to test in humans any vaccine that would
put those people at risk of the disease."

The reporter, obviously baffled, kept pressing Brandt, who accused the
journalist of "presupposing the kind of vaccine" they intended to develop.
"I'm not presupposing anything," the journalist snapped back.

"We don't have a vaccine at the moment," said Brandt. "And we would
certainly take all ..."

"You're talking about having one in a couple of years," the journalist
interrupted, raising the question again about how they planned to stage tests
of the vaccine in healthy volunteers.

"Well, as soon as we see the vaccine, then I'll be able to answer that
question."

Had Brandt understood vaccine development better, this testy exchange
need not have happened. Long before AIDS came around, scientists well recognized
that the testing of a vaccine against a lethal disease raises difficult
ethical questions. Inevitably, the issue comes down to weighing risks against
benefitsand carefully describing the two sides of the scale to anyone who
volunteers for the trial. What is more, Brandt's charge that the journalist was
"presupposing" the type of AIDS vaccine that would be developed was particularly
off-base because if anyone was presupposing anything about the formula
for an AIDS vaccine, it was Gallo, as he revealed in a subsequent answer.

"You keep asking about the vaccine, when it comes up, what's going to
be available in two years," Gallo said to a reporter who had not asked about
the vaccine. "As best as a scientist can calculate. We can't predict anything
100%. But you've got to give some answers."

Gallo, who had never made a vaccine against anything, went on to detail
a recipe for an AIDS vaccine that, instead of relying on the entire virus like
the traditional live and killed approaches, only called for using a piece of the
agent that had been produced with genetic engineering techniques. Just such
a hepatitis B vaccine was then being engineered that contained the surface
protein, or envelope, of that virus. When it came to AIDS, said Gallo, the
same logic would apply. "In my view, you'd vaccinate with the envelope prorein
of the virus," said Gallo. "We'll go to recombinant technology, we are
doing that now, and we will produce the protein that way. That protein, I
would certainly be willing to take if I were a high-risk person, and I'd do it
voluntarily.... That's the direction we're kind of thinking about."

* * *

A COUPLE DAYS AFTER THE PRESS CONFERENCE. June Osborn, then a
University of Wisconsin virologist who headed the NIH's AIDS Advisory
Committee, received a phone call from an outraged gay researcher she knew
in Los Angeles. The researcher explained to her how hard he and his colleagues
had been working to convince the gay community in Los Angeles that
sex clubs and bathhouses were spreading AIDS. Before the press conference,
the researcher said these businesses were empty. But Heckler's enthusiasm
about the development of a vaccine had created a euphoric sense that the end
of the epidemic was near. Last night, he complained, he saw a bathhouse with
a four-hour waiting line.

Media reports from the press conference did dutifully report Heckler's
comment that an AIDS vaccine would be ready for testing in about two years.
They also by and large left out Brandt's more declarative statement that, by
three years, a vaccine probably would be on the market. Still, regardless of
the specific language used in the distilled and packaged versions of what was
said in the Hubert H. Humphrey auditorium on April 23, 1984, the public
heard a simple message: An AIDS vaccine was just around the corner.

Looking back on the press conference nearly 14 years later, many of the
participants had serious regrets about the vaccine predictions. Brandt said he
still "winced" every time he heard reference to an AIDS vaccine being tested
in two years, and he had completely forgotten about his own declaration of a
marketed vaccine in three. "Certainly there wasn't much experience with the
whole idea of a vaccine," acknowledged Brandt. "There was a general belief
moving about at the time that this was really going to be a fairly easy nut to
crack. It was just a matter of time until some quick breakthrough, or whatever
the word is, until that happened. I suspect if we really understood the complexity
of the organism at that time, things might have happened differently."

Gallo aknowledged that, at the time, he had "zero previous experience
in my life on a vaccine" and only the crudest understanding of the basic
immune mechanisms that protect people from infectious diseases. "You can't
imagine the level of my own feeling of confidence at that time," he said, by
way of explaining his role in the optimistic predictions, ills lab had just
played major roles in the discoveries of HTLV-I and HTLV-II, as well as
uncovering a critical immune system messenger, interleukin-2, that tells cells
to grow. With AIDS, they had convincing evidence for the first time that a
virus isolated from ailing people caused the disease. Their ability to mass-produce
this so-called HTLV-IIIwhich later became known as human
immunodeficiency virus, HIV, when it proved to have no relationship to the
other HTLVslaid the groundwork for a blood test, treatment, and a vaccine.
They were hot on the trail of discovering which cells the AIDS virus preferred,
the various ways it was transmitted, and what genes it had. "There
was so much data pouring in that I, too, thoughtprobably believedwe
could have solved the whole bloody thing, you know?"

Gallo's greatest regret is that the press conference was held at all, as it
violated an agreement he had made with Montagnier and the other Pasteur
researchers earlier that monthand seriously incensed them. "I was terribly,
terribly nervous," remembered Gallo. "I had massive conflicting emotions. I
felt this shouldn't have been done. I didn't act strong enough that we should
have waited until we compared the virus with the French and made a joint
announcement." The perception that Gallo made a credit grab was compounded
by Heckler's laryngitis, which forced her to skip the parts of her
prepared statement that acknowledged the Pasteur's contributions.

There is, of course, no way of knowing for certain whether an HIV vaccine
would be any closer to market had the announcement of the discovery
of the cause of AIDS been handled differently. But the April 23, 1984, press
conference and the attendant backroom imbroglios communicated in bold
type that the search for an AIDS vaccine was off to a bad start.

MR. SPEAKES: Lester's beginning to circle now. He's moving in front.
(Laughter.) Go ahead.
Q: Since the Center for Disease Control in Atlanta(laughter)reports
MR. SPEAKES: This is going to be an AIDS question.
Q: that an estimated
MR. SPEAKES: You were close.
Q: Well, look, could I ask the question, Larry?
MR. SPEAKES: You were close.
Q: An estimated 300,000 people have been exposed to AIDS, which can be
transmitted through saliva. Will the President, as Commander-in-Chief,
take steps to protect Armed Forces food and medical services from
AIDS patients or those who run the risk of spreading AIDS in the same
manner that they forbid typhoid fever people from being involved in the
health or food services?
MR. SPEAKES: I don't know.
Q: Could youIs the President concerned about this subject, Larry
MR. SPEAKES: I haven't heard him express
Q: that seems to have evoked so much jocular
MR. SPEAKES:concern.
Q: reaction here? Iyou know
Q: It isn't only the jocks, Lester.
Q: Has he sworn off water faucets
Q: No, but, I mean, is he going to do anything, Larry?
MR. SPEAKES: Lester, I have not heard him express anything on it. Sorry.
Q: You mean he has noexpressed no opinion about this epidemic?
MR. SPEAKES: No, but I must confess I haven't asked him about it. (Laughter.)
Q: Would you ask him Larry?
MR. SPEAKES: Have you been checked? (Laughter.)